Descendent Necrotizing Mediastinitis

Authors: J. Šafránek 1;  Š. Vejvodová 1;  J. Nasswetter 2;  J. Martínek 2
Authors‘ workplace: Chirurgická klinika LF UK v Plzni a FN Plzeň 1;  Otorinolaryngologická klinika LF UK v Plzni a FN Plzeň 2
Published in: Otorinolaryngol Foniatr, 68, 2019, No. 1, pp. 36-40.
Category: Original Article


Objective: Descendent necrotizing mediastinitis (DNM) results from infection in the orofacial region. A serious septic state requires an early surgical intervention.

Methods: The retrospective evaluation of a cohort of patients who underwent surgery for DNM at our workplace in 2017.

Results: The surgery of 122 paratonsillar abscesses and 9 parapharyngeal abscesses was performed at the ORL Clinic of Faculty Hospital in Plzen in 2017. The surgery for DNM concerned four patients, two women and two men of the average age of 53 years. The introductory anaerobic cultivation was always Fusobacterium and the aerobic one revealed Streptococcus anginosus in three cases. All patients initially underwent tonsillectomy and external cervical drainage. All patients subsequently needed transthoracic revision and lavage unilaterally (twice), bilaterally (twice) and repeatedly (three times). The mean duration of hospitalization was 36 days, and there was no 30-day mortality. C-reactive protein (CRP) values were in the range of 295-392 mg/l, mean 336,5 mg/l. Leukocytosis was in the range of 16.2-40.7, mean 24.8x109/l.

Conclusion: Tonsillectomy and sufficient external cervical drainage prevents the development of mediastinitis, which in the advanced stage mostly requires transthoracic approach, regular redressement and long-term intensive care.


descendent necrotizing mediastinitis – mediastinum drainage


1. Estrera, A. S., Landy, M. J., Grisham, J. M. et al.: Descending necrotizing mediastinitis. Surg. Gynecol. Obstet., 157, 1983, s. 545-552.

2. Freeman, R. K., Vallieres, E., Verrier, E. D. et al.: Descending necrotizing mediastinitis: an analysis of the effects of serial surgical debridement on patient mortality. J. Thora.c Cardiovasc. Surg., 119, 2000, s. 260-267.

3. Hájek, M.: Akutní zánět mediastina. In: Chirurgie pro praktického lékaře. Hájek M., Praha, Grada Publishing, s.r.o., 1995, s. 153.

4. Izumoto, H., Komoda, K., Okada, O. et al.: Successful utilization of the median sternotomy approach in the management of descending necrotizing: report of a case. Surg. Today, 26, 1996, s. 286-288.

5. Klečka, J., Šimánek, V., Vodička, J. et al.: Akutní mediastinitis – optimální diagnostická a léčebná opatření. Rozhl. Chir., 88, 2009, 5, s. 253-258.

6. Liptay, M. J., Kim, A .W.: Acute and chronic mediastinal infections. In Shields T. W., Licicero III J., Reed C. E., Feins R. H: General thoracic surgery. 7th edition. Philadelphia, Lippincott Williams & Wilkins, 2009, s. 2181-2186.

7. Min, H. K., Choi, Y. S., Shim, Y. M. et al.: Descending necrotizing mediastinitis: a minimally invasive approach using video-assisted thoracoscopic surgery. Ann. Thorac. Surg., 77, 2004, s. 306-310.

8. Ris, H. B., Banic, A., Furre, M. et al.: Descending necrotizing mediastinitis: surgical treatment via clamshell approach. Ann. Thorac. Sur., 62, 1996, s. 1650-16544.

9. Roberts, J. R.,Smythe, W. R.,Weber, R. W. et al.: Thoracoscopic management of descending necrotizing mediastinitis. Chest, 112, 1997, s.850-554.

10. Shimizu, K., Otani, Y., Nakano, T. et al.: Successful video-assisted mediastinoscopic drainage of descending necrotizing mediastinitis. Ann. Thorac. Surg., 81, 2006, s. 2279-2281.

11. Singhal, P., Kejriwa, N., Lin, Z. et al.: Optimal surgical management of descending necrotising mediastinitis: Our experience and review of literature. Heart, Lung and Circulation, 17, 2008, 2, s. 124-128.

12. Stella, F., Petrella, F.: Transseptal transpericardial approach for acute descending necrotizing mediastinitis. J. Thorac. Cardiovasc. Surg., 129, 2005, 1,s. 212-214.

13. Šafránek, J., Špidlen, V., Skalický, T. et al.: Descendentní nekrotizující mediastitinitida – chirurgická léčba. Rozhl. Chir. 91, 2012, 7, s. 362-367.

14. Šmat, V.: Akutní a chronická mediastinitis, In: Chirurgie plic a mediastina. Řehák F., Šmat V., Praha, Avicenum, 1986, s.. 207-208.

15. Vomela, J.: Mediastinitis acuta- diagnostika, terapie. Sborník prací lékařské fakulty MU Brno, 116, 2000, s. 214.

Audiology Paediatric ENT ENT (Otorhinolaryngology)
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